(ONE ADULT PER FORM - Please type or print clearly.) NOTE: Prior to your entry and stay at the Gallina Canyon Ranch, each visitor must deliver a signed and dated original of this Liability Disclaimer and Waiver (the "Waiver"). Please feel free to photocopy this Waiver as needed. PLEASE READ CAREFULLY BEFORE SIGNING THIS WAIVER. As evidenced by my signature below, I acknowledge and agree as follows:
1. I am voluntarily visiting and staying at Gallina Canyon Ranch and assume full responsibility for my personal welfare and my personal property while at Gallina Canyon Ranch at all times and under all circumstances.
2. I understand that there are free-ranging livestock on and around Gallina Canyon Ranch and that I voluntarily enter the area knowing livestock can pose a safety hazard to me and my property and accept the risks associated therewith.
3. I will not hold the owners and/or employees of Gallina Canyon Ranch liable for any personal injury or loss occurring to me or my personal property as a result of my visiting or staying at Gallina Canyon Ranch under any circumstances.
4. I assume all responsibility for my conduct related to my visit to Gallina Canyon Ranch and the ranch site's environment, including its protection and conservation.
5. I understand that I will be staying in a remote wilderness and that any medical or other emergency services at Gallina Canyon Ranch are nonexistent and that I visit Gallina Canyon Ranch voluntarily and at my own risk.
6. I understand that if I choose not to comply with the prohibitions and safety requirements as listed below, I will be asked to leave without refund and I agree to comply:
> No camp fires except in the three approved fire rings > No pets
> No firearms > No hunting
> No smoking
7. I understand and I am aware that there are risks involved in my visiting and staying at Gallina Canyon Ranch, including the rugged nature of the site, and take full responsibility for my safety and well being. I hereby release any and all claims, demands, and causes of action of whatever kind and character which I may have now or in the future against Gallina Canyon Ranch, the owners of the Gallina Canyon Ranch, and their respective agents, employees, officers, directors, members, managers, and representatives arising out of or in any way related to my entry onto the Gallina Canyon Ranch and/or for any injury, loss or illness occurring to me or to anyone through whom I may claim at Gallina Canyon Ranch RESULTING FROM ACCIDENT, NEGLIGENCE, OR MY PARTICIPATION IN ANY AND/OR ALL ACTIVITIES related to my stay at Gallina Canyon Ranch. This Waiver is binding upon my heirs, executors and assigns.
8. I hereby agree, on behalf of myself and on behalf of any person or entity claiming by, through or under me, to defend, indemnify and hold harmless Gallina Canyon Ranch, the owners of the Gallina Canyon Ranch, and their respective agents, employees, officers, directors, members, managers, and representatives, from any and all claims, demands, and causes of action of whatever kind and character which may ever be brought against Gallina Canyon Ranch, and their respective agents, employees, officers, directors, members, managers, and representatives, whether such claims are known or unknown, at law or in equity, arising out of or in any way related to my entry on and visit to the Gallina Canyon Ranch.
9. My dated signature indicates I have read and understood the foregoing and agree to all of the terms of this Waiver. (Please print clearly)
THIS IS A LEGAL CONSENT AND RELEASE FORM. PLEASE READ IT CAREFULLY AND BE SURE YOUR QUESTIONS HAVE BEEN ANSWERED BEFORE SIGNING.
Executed this _____ day of ____________________, 20___.
Please mail a signed copy of this waiver to:
Andrew and Elizabeth Sebastian
Post Office Box 706
Abiquiu, New Mexico